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Show Burdens Encountered By the Uninsured in the Search for Hospital Care: Are Tax-Exempt Hospitals Fulfilling Their Charitable Obligations: Jennifer M. Lambert Subcommittee, were in response to a series of newspaper arti-cles in the Wall Street Journal and the New York Times, nearly a year-and-a-half after they were published, regarding the billing practices of the Yale-New Haven Hospital in New Haven, Connecticut (Community Catalyst 2003). The articles exposed the collection practices at Yale-New Haven and other U.S. hospitals , which included liens on homes, wage garnishments, and jail time, in order to retrieve bad debt. Such practices were the cause of financial turmoil among many individuals that had filed for bankruptcy. The news of such practices quickly spread, causing an eruption of uncovered information and new committees to investigate the motives behind the harsh hospital billing practices. The Hospital Industry's Rebuttal To refute allegations of harsh and unfair billing practices, representatives for the hospitals have rebutted: [Hospitals] say they are forced to recoup every dollar they can because health-care costs are soaring, and insurers and the government are cutting their reimbursements for services. Hospitals have also been squeezed by the rising numbers of the uninsured.. .who often don't pay their bills. Hospitals say they shouldn't be forced to bear the disproportionate financial burden of a national crisis (Lagnado 2003). In defense, hospitals operate as a business that requires profit and money in order to provide services to the insured and uninsured alike. Hospitals claim that "you can't solve the issue of millions of uninsured by simply turning to hospitals whose financial conditions are quite fragile and say, 'You do it,'" stated by Howard Peters, Senior Vice President of the Illinois Hospital Association (Lagnado 2003). The policy question is how to fairly apportion limited hospital resources between uninsured and insured individuals, in order to provide hospitals with reimbursement rates that will compensate them for their services without mistreating any one group. Recent articles published in Utah's newspapers also sympathize with burdensome charity care practices (Lampros 2004). In order to compare Utah hospitals with those of the nation, the remainder of this study will focus on Utah and its uninsured. Understanding Utah's Populace In 2002, Utah was one of nine states whose poverty rate increased. More than 24,000 Utahns, mainly two-parent households, were considered poor. Three in four impoverished families in Utah in 2002 had a working member in the household (Utah Department of Health and Human Services 2003, 3). Ironically, the greatest economic insecurity is rising among middle-class whites. Consequently, bankruptcy has become common-place among middle-class Utahns. In fact, 1 in 36.7 Utah households have filed for bankruptcy, the highest in the nation. Among the reasons for these statistics are unemployment rates and soaring healthcare costs (Utah Department of Health and Human Services 2003, 9). Utah's Uninsured "According to the United States Census Bureau, approximately 335,000 Utahns are uninsured" (Health Access Project 2003). Statistically, estimates for Utah's uninsured vary drastically. The Current Population Survey estimates 13.4 percent of Utah's population as uninsured; whereas, the Utah Department of Health's Health Status Survey estimates a four percent difference, with just nine percent uninsured (Utah Department of Health and Human Services 2003, 22). In spite of the discrepancies in reporting, it is apparent that a number of Utahns lack health insurance and/or access to health care. The effects of uninsurance on the community can be burdensome, as stated by the Poverty in Utah 2003 report: Uninsured Utahns are less likely to have a regular source of care and more likely to delay or go without needed care. This has serious health and economic implications: health care delivered in emergency rooms at later stages of illness can be four times as expensive as primary care, and these additional costs are passed along to private payers or to the state and federal government as uncompensated care. Importantly, the vast majority of Utah's uninsured, 76 percent, are working either full-time or part-time or living in households with workers (Utah Department of Health and Human Services 2003, 24). In order to provide for uninsured individuals who cannot afford health insurance, including the 76 percent of workers who are not eligible, or are not provided health insurance through their employers, Utah has developed two programs that work together for those who do not meet FPL guidelines to qualify for Medicaid. These programs are the Primary Care Network and the Health Access Project Utah's Healthcare Programs The Primary Care Network (PCN) extends healthcare access to individuals at or below 150 percent of the FPL. The PCN provides coverage for certain services, although many services are not covered. Basic services may include physician office visits, hearing and vision screenings, very basic dental care, emergency care, lab and x-ray, and prescription drugs (State Coverage Initiatives 2003, 1). The PCN provides four enrollment periods per year, after which, it does not allow new enrollees. Furthermore, unmarried individuals without dependant children must wait for a specified enrollment period to apply. Because the PCN does not cover inpatient care, critics have discarded the PCN as a solution to extending health insurance to the uninsured. Individuals who qualify for PCN are required to pay a $50 enrollment fee, in addition to co-pays, which is argued to be beyond what the indigent can pay. Lastly, PCN enrollees must rely on charity care for services that are not included in the PCN. The Health Access Project (HAP) was "established in 2001 through a federal Community Access grant provided to fulfill community healthcare services to the uninsured" (Utah 28 |